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New Jersey Division of Fire Safety
Office of the State Fire Marshal - Fire Fatality Report Form
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Date of Incident:
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Alarm Time (24Hr):
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Day of the Week
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Incident Address:
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Municipality:
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County:
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Zip Code:
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Fire Department Name:
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FDID:
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Name of Person Completing Form:
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Email:
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Cell Phone:
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Fire Chief Name (If Different from Above):
Chief Cell Phone:
Chief Email:
NFIRS Participant: (Check One)
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Yes
No
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